Psych Flashcards
Histrionic Personality Disorder
Excessive superficial emotionality and attention-seeking
- Inappropriate sexual seductive/provocative behavior
- Considers relationships more intimate than reality
Borderline Personality Disorder
Attention-seeking
Manipulative
Self-injurious of suicidal behavior
Intense anger
Paranoid Personality Disorder
- Pervasive pattern of distrust and suspiciousness, beginning an early adulthood and occurring in a variety of settings.
- Believes being exploited and deceived by others
- Interprets benign comments and events as threats, reacts angrily
- Hold grudges
- Questions loyalty without justification
Suicide
RF(strongest and others)
RF:
- STRONGEST - prior suicide attempt
- OTHER: Psych disorder, depression, single, live alone, unemployed, physical illness, family hx of suicide, access to firearms, substance abuse, impulsivity
Suicide contracts have NOT been proven to be effective!!
Acute Stress vs PTSD
Acute stress:
>3 days <1month
Avoidance, intrusion, dissociation, insomnia/hypervigilance
Tx: CBT
PTSD:
>1 month
Depression
1st episode: Tx duration
Older age dx sx ,comp
Tx
Relation with CVD
1st episode: take anti-depressant for ~6 months. If higher risks/recurrent, continue for 1-3 years. If >3 lifetime episodes, continue indefinitely.
Late Onset >65y/o:
- Can present like cognitive impairment aka Pseudodementia (affect thinking, learning, memory & decision-making).
- Can increase risk of developing dementia.
Tx: SSRI, SNRI, NDRI (bupropion), TCA (amitriptyline, nortripyline) MAOI (phenelzine, tranylcypromine), Other (mirtazapine, trazodone, vortioxetine), CBT and interpersonal psychotherapy. Supportive psychotherapies not helpful as mono therapy.
Consider adjustment disorder if MDD criteria is not met
Bidirectional link between major depression and coronary artery disease. Depression can increase risk for morbidity and mortality in patients with cardiovascular disease.
Postpartum depression vs postpartum blues
Same criteria a major depressive disorder ( >2 weeks of 5 of 9 symptoms)
Postpartum blues: milder depressive sx, peaks at 5 days but resolved within 2 weeks.
Psychosis
Substance-induced
- Cannabis-induced psychotic disorder can convert to a primary psychotic disorder in 40% of cases but can also resolve with prolonged abstinence.
- Can also occur with cocaine, amphetamines, and bath salts
Schizophrenia
Good vs poor prognostic factors
Tx
Schizoeffective (sx)
Good prognostic factors:
- Later onset
- Female
- Acute onset with precipitant
- Predominantly positive symptoms (hallucinations, delusions)
- No family history
- Short duration of active symptoms
Poor prognostic factors:
- Onset in childhood or adolescence
- Male
- Gradual onset (prodrome), no precipitant
- Predominantly negative symptoms (flat affect, loss of motivation, anhedonia)
- Family history of psychotic illness
- Long duration of untreated psychosis
Tx:
- Antipsychotic for positive sx
- Social skill training for negative sx
If patient is non-compliant: exploring patient’s knowledge of prior mood episodes, compared to current mood episodes. This can help assess whether they are aware of their current state.
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Schizoaffective disorder, bipolar type
Major depressive or manic episodes concurrent with symptoms of schizophrenia
- Delusions or hallucinations for >2 weeks in the absence of major depressive or manic episode
Bipolar
Tx
Tx: Lithium, valproate, carbamazepine, lamotrigine (mood stabilizers), atypical antipsychotics
Refractory: Add antipsychotic (clozapine)
In pregnancy:
- 1st or 2nd generation Antipsychotics (haloperidol, risperidone, olanzapine)
- ECT is safe in pregnancy, rapid response for urgent treatment
- Lamotrigine but takes weeks to titrate
- Try not to use lithium
- Dont use valproate or carbamazepine
Anorexia
Indication for hospitalization
Refeeding syndrome (Sx, Tx)
Indication for hospitalization
- Pulse <40
- BP < 80/60 or lightheadedness
- orthostatic changes
- Hypothermia
- <70% of expected weigh or BMI <15
- Acute food refusal
- Suicidality or psychosis
Refeeding syndrome:
- Electrolyte derangements (Phosphorus, Potassium, Magnesium and thiamine and repleted quickly.
- Dysarrhythmia d/t hypokalemia/hypomagnesemia
- CHF –> pulmonary and peripheral edema
- Seizures
- Wernicke encephalopathy
TX: thiamine repletion, correct electrolytes (esp phosphate - oral preferred)
Catatonia
Sx, Tx
Sx:
- Immobility or excessive purposeless activity.
- Mutism, stupor (decreased alertness and response to stimuli)
- Negativism (resistance to instructions and movement)
- Posturing (assuming positions against gravity)
- Waxy flexibility (initial resistance, then maintenance of new posture)
- Mimicking speech and movement
Tx:
- Benzodiazepine (lorazepam)
- Electroconvulsive therapy
ADHD
Tx
- Research shows that 1/3– 2/3 of children diagnosed with ADHD will experience persistent symptoms in adulthood.
- Hyperactivity often improves with age, but attention deficit and impulsivity often persist.
Tx:
- Methylphenidate and Amphetamines (stimulants) are 1st one for adolescence or school age children >6y/o, including .
- Research demonstrates that stimulant therapy DOES NOT increase the risk for substance use or abuse (family history of abuse is not contraindicated).
- Non-stimulant medication would be preferred if the patient has a personal history of substance abuse.
Somatic symptoms disorder vs illness anxiety disorder
Factitious vs Malingering
Somatic: >1 unexplained symptom
Management: regular visits with same doctor
Illness anxiety: Minimal or no symptoms, preoccupation with idea of having serious illness
Factitious aka Munchausen: Falsification of symptoms with NO obvious external gain
Malingering: Falsification of symptoms with obvious external gain
